EASTERN WASHINGTON UNIVERSITY HEARING AND SPEECH

Provider Demographics

• NPI: 1114255866
• Name: EASTERN WASHINGTON UNIVERSITY HEARING AND SPEECH
• Entity Type: Organization
• Organization Name: EASTERN WASHINGTON UNIVERSITY HEARING AND SPEECH
• Authorized Official - Title/Position: OFFICE MANAGER
• Authorized Official - Prefix: MS
• Authorized Official - First Name: SHYLA
• Authorized Official - Last Name: RODGERS
• Authorized Official - Phone: 509-358-7581
• Mailing Address - Street 1: 310 N RIVERPOINT BLVD
• Mailing Address - Street 2: BOX V
• Mailing Address - City: SPOKANE
• Mailing Address - State: WA
• Mailing Address - Zip Code: 99202-1675
• Mailing Address - Country: US
• Mailing Address - Phone: 509-358-7581
• Mailing Address - Fax: 509-368-6890
• Practice Address - Street 1: 310 N RIVERPOINT BLVD
• Practice Address - City: SPOKANE
• Practice Address - State: WA
• Practice Address - Zip Code: 99202-1675
• Practice Address - Country: US
• Practice Address - Phone: 509-358-7581
• Practice Address - Fax: 509-368-6890
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2009-11-18
• Last Update Date: 2009-11-18

Provider Licenses

State	License ID	Taxonomies
WA	LD00002341	231H00000X
WA	LD00001585	231H00000X
WA	LL00001590	235Z00000X
WA	LL00003190	235Z00000X
WA	LL00002995	235Z00000X
WA	LL00003252	235Z00000X
WA	LL00003216	235Z00000X
WA	LL00003023	235Z00000X
WA	LL00003049	235Z00000X
WA	LL00003515	235Z00000X
WA	LL00004465	235Z00000X
WA	LL00003082	235Z00000X
WA	LL00003031	235Z00000X
WA	LL00002011	235Z00000X
WA	LL00004795	235Z00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty
No	231H00000X	Speech, Language and Hearing Service Providers	Audiologist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	7915309	Medicaid
WA	9049396	Medicaid
WA	7101181	Medicaid